Tramadol Side Effects and Dependence Risks Explained

Like other opioid medicines, tramadol can cause opioid side effects such as drowsiness, dizziness, nausea and constipation, while some reactions can be more serious.

What are the typical side effects of tramadol?

Common tramadol side effects affect more than 1 in 100 people. They include:

• Headache
• Feeling sleepy, tired, dizzy or “spaced out”
• Nausea or vomiting
• Constipation
• Dry mouth
• Sweating
• Low energy

These effects may improve as your body adjusts to tramadol. Speak to your doctor or pharmacist if they are persistent or troublesome.

Drowsiness and dizziness can impair concentration and coordination. Do not drive, cycle or use machinery if tramadol makes you sleepy or affects your alertness.

Which tramadol side effects are serious?

Most side effects are not serious, but some symptoms require prompt medical assessment.

The NHS advises contacting a doctor or NHS 111 if you develop:

• Severe dizziness or weakness
• Hallucinations
• Confusion
• Very severe sleepiness
• Difficulty passing urine or an inability to urinate

Some tramadol warning signs require emergency treatment.

Call 999 or go to A&E if you develop:

• A seizure or fit
• Breathing difficulties
• Short or shallow breathing

A serious allergic reaction, including anaphylaxis, can also occur rarely. Sudden swelling, breathing difficulty or loss of consciousness requires emergency medical attention.

Can tramadol cause breathing problems?

Yes. Tramadol can cause respiratory depression, a condition in which breathing becomes slower or less effective. This is an important risk with opioids and can be especially of concern if tramadol is combined with other medicines or substances that cause sedation.

Taking more tramadol than you’re prescribed can also increase the risk of serious side effects, like difficulty breathing and loss of consciousness.

The risk is particularly important when tramadol is combined with other central nervous system depressants. Always tell your doctor or pharmacist about other medicines you are taking before starting or changing tramadol treatment.

The risk of respiratory depression can be higher when tramadol is combined with other medicines or substances that cause sedation. This is particularly important because excessive opioid-related sedation can progress to dangerously slow or ineffective breathing.

Can tramadol cause seizures?

Yes. Seizures or fits are a recognised risk of tramadol.

Some factors and combinations of medicines may increase the likelihood of seizures. Therefore, it is recommended that people with conditions associated with seizures should use tramadol with caution and that healthcare professionals should be aware of all medicines being taken.

Tramadol with some antidepressants and other medicines may also increase the risk of seizures. That’s why it’s important not to start, stop or mix medicines without checking with a doctor or pharmacist.

Can tramadol interact with other medicines?

Yeah. Tramadol can interact with many other drugs, including some antidepressants, other pain relievers, and drugs used to treat sleep, anxiety, allergies, and infections.

Tramadol, when taken with some antidepressants, can increase the risk of seizures or serotonin syndrome. MAOIs and tramadol should not be taken together because of serious interactions.

Signs of serotonin syndrome include agitation, confusion, sweating, shivering, muscle twitching, increased heart rate and changes in body temperature. These symptoms need to be seen by a doctor as soon as possible, especially if you start or combine medicines that affect serotonin.

Other medicines, including carbamazepine, buprenorphine, ondansetron and rifampicin, can also affect tramadol treatment. Codeine-containing medicines should not be taken alongside tramadol unless specifically advised by a healthcare professional.

Tell your doctor or pharmacist if you are taking any other medicines. This includes any medicines you buy without a prescription from a pharmacy, supermarket or health food shop.

Can alcohol make tramadol side effects worse?

Yes. Alcohol can increase some of the sedative effects of tramadol.

The NHS advises avoiding alcohol while taking tramadol because you are more likely to experience side effects such as sleepiness. Combining an opioid with other substances that depress the central nervous system can also increase safety concerns.

Can you become dependent on tramadol?

Yes. Tramadol can cause dependence and addiction.

Repeated use can lead to tolerance, dependence and withdrawal symptoms.

Dependence does not automatically mean someone is addicted. NICE explains that dependence is characterised by tolerance and withdrawal, whereas addiction additionally involves features such as cravings, loss of control, overuse and continued use despite harm.

Physical dependence can develop even when tramadol has been taken as prescribed. This means the body has got used to the drug and if you cut down or stop using it you could get withdrawal symptoms. This is not the same as addiction, which is problematic patterns of use.

The risk of addiction is particularly important if opioids are used over a longer period of time. The UK government advises that tramadol is an opioid with a very high potential for addiction, particularly in long-term use.

What are the signs of tramadol dependence or addiction?

Possible signs include:

• Feeling that you need tramadol more frequently
• Craving tramadol
• Taking more than prescribed
• Finding it difficult to control how much you take
• Continuing to use it despite harmful effects
• Seeking additional prescriptions
• Experiencing withdrawal symptoms when you reduce or stop treatment

The NHS specifically notes that someone who is addicted may find it difficult to stop taking tramadol or feel that they need to take it more often than necessary.

What is tramadol tolerance?

Tolerance means that the body becomes accustomed to tramadol, so the same dose may become less effective over time.

The NHS notes that people taking tramadol for a long period can develop tolerance and may require higher doses to achieve the same level of pain control.

Tolerance is not the same as addiction but both can occur with long term use of opioids. Taking more than the prescribed dose without consulting a doctor is dangerous because increased exposure to opioids can cause serious side effects including overdose.

Can long-term tramadol use make pain worse?

In some people, prolonged opioid treatment can contribute to increased sensitivity to pain, known as hyperalgesia.

The NHS notes that some people taking tramadol for severe pain over a long period may become more sensitive to it. If hyperalgesia happens, the doctor may gradually reduce the dose.

This increased sensitivity to pain is not the same as tolerance, where the same amount becomes less effective. If pain changes or gets worse during use of tramadol long-term then this should be discussed with the prescriber and not by increasing the dose yourself.

What happens if you stop tramadol suddenly?

Stopping tramadol suddenly after regular use can cause withdrawal symptoms, because the body may have become accustomed to the medicine.

Possible symptoms include:

• Anxiety or agitation
• Shaking
• Sweating
• Difficulty sleeping
• Restlessness
• Body aches
• Palpitations
• Panic attacks

The NHS advises people who have been taking tramadol for more than a few weeks not to stop suddenly without speaking to their doctor. The dose will usually be gradually reduced to lessen withdrawal symptoms.

Withdrawal symptoms can vary in severity and may be more noticeable after longer treatment or higher doses. If symptoms become difficult to manage during dose reduction, speak to your prescriber rather than stopping treatment abruptly.

What happens if you take too much tramadol?

Taking more tramadol than prescribed can cause an overdose. Symptoms may include severe sleepiness, nausea, dizziness, difficulty breathing and loss of consciousness.

The amount that can cause an overdose varies between individuals, so there is no reliable way to determine a “safe” extra amount.

Do not take additional tramadol to increase pain relief or use another opioid to “top up” the effect without professional advice. UK opioid safety guidance specifically advises against increasing the dose or taking extra opioid medicines without advice from the prescriber or pharmacist.

If you have taken too much tramadol, seek urgent medical advice. Call 999 for severe breathing difficulties, unconsciousness or other life-threatening symptoms.